Confused About Cholesterol?

Reviewed by Robert Ehrman, MD

Confused about cholesterol? Unsure which fats are good and which are bad? Wondering if you can eat eggs? Well, wonder no more. We’ll set the record straight on some of the “facts” and “fictions” about cholesterol and eating for a healthy heart.

1. Cholesterol is bad for your body.

FICTION. Our bodies need cholesterol to help build cells, hormones and bile acids. It also helps our nerves work properly. The liver makes all the cholesterol we need. The problem comes in when we get too much cholesterol from saturated or trans fats and cholesterol in food. Too much cholesterol can lead to plaque build-up in the artery walls, which may cause blood clots to develop. Blood clots can lead to heart attacks, stroke and blood flow problems in the legs.

2.  Drinking red wine can raise HDL (“good”) cholesterol levels.

FACT.  It’s true! Red wine contains several types of nutrients, called phytonutrients, which help increase the body’s level of HDL cholesterol.  HDL cholesterol protects against heart disease. Other types of alcohol can raise HDL, too, but red wine seems to have more of a benefit. But watch out: alcohol may raise blood pressure levels and give you extra unwanted calories. Many people shouldn’t drink any alcohol. If you do, keep it to two servings daily if you’re a man and one serving daily if you’re a woman. A single serving is 5 ounces of wine, 12 ounces of light beer or 1 ½ ounces of distilled spirits. Talk with your health care provider about how to drink alcohol safely.

3. If you have a high cholesterol level, you have to take medicine.

FICTION.  Many people need to take medicine to help lower their cholesterol levels, but others may be able to lower their levels by making better food choices and by doing more physical activity. The first place to start is to cut back on saturated fat, which is found in red meat, cheese, butter and whole milk. You should also cut back on trans fats, which are found in some margarines, fast food, and many store-bought cookies and crackers. Eating foods rich in soluble fiber, such as oatmeal, beans, fruits and vegetables, is also very helpful. Fruits and vegetables have nutrients that can help lower cholesterol, and daily physical activity helps boost the good HDL cholesterol levels. Even if you must take medicine, you still need to eat healthy and be active.

4.  People with diabetes should have their cholesterol levels checked at least once a year.

FACT. Because people with diabetes are twice as likely to have heart disease as people without diabetes, it’s important to keep track of any risk factor you might have for heart disease. You can do this in several ways: See your health care provider regularly, keep your A1C and blood glucose levels within your target range, get your blood pressure checked at each provider visit, and have your lipid (fat) levels, which includes LDL, HDL and triglycerides, checked at least once a year. The lipid goals for most people with diabetes are:

  • LDL: less than 100, or less than 70 if you have heart disease
  • HDL: greater than 40 for men; greater than 50 for women
  • Triglycerides: less than 150

Ask about your numbers and write them down. Talk with your health care team about how you can make your numbers better if they are not in your target range. Some “facts” really may be fiction, so speak to your health care provider about all health issues that are important to you.

5. If your cholesterol is high, you can’t eat eggs.

FICTION.  Eggs can be part of a heart-healthy eating plan, even if you have a high cholesterol level in your blood. Egg yolks contain a fair amount of cholesterol (about 213 milligrams). But it’s really the trans fat in food that raises blood cholesterol. And because eggs are a good source of protein, Vitamin A and iron, it’s OK to include them in your eating plan. People with diabetes should aim for no more than two to three egg yolks each week. If you’re an egg lover, you can eat egg whites every day because they don’t have any cholesterol.

6. Foods that contain plant stanols or plant sterols can lower LDL (“bad”) cholesterol.

FACT. Plant stanols and plant sterols are found in many fruits, vegetables, beans, nuts, seeds and vegetable oils.  These powerful nutrients help block the absorption of cholesterol in the intestine, which lowers LDL cholesterol.  Several brands of margarine now contain plant stanols and sterols, as well as some yogurts, orange juices and energy bars.  The goal is to aim for between two to three grams of plant stanols and sterols each day to help bring the body’s LDL level down.

7. As long as a food is trans fat-free, it won’t raise your cholesterol level.

FICTION.  Trans fat is a man-made fat that food companies add to certain foods. This type of fat keeps foods fresher for a longer amount of time and helps make the food feel better in your mouth. Trans fat can raise bad LDL cholesterol and lower good HDL cholesterol. Food companies must list trans fat on their food labels. Many companies have stopped using trans fat in their products. A food with 0.5 grams or less of trans fat is listed as “0 grams” of trans fat on the label. If you eat more than one serving of that food, you may still be getting trans fat in your diet. Check the ingredient list: if you see the words “shortening” or “partially hydrogenated vegetable oil” in the list, that food contains trans fat. Also keep in mind that foods may contain 0 grams of trans fat, but still contain saturated fat, which can also raise LDL cholesterol. Try to choose foods with no more than 1 gram of saturated fat per serving.

8. If your cholesterol is high, you should follow a low-cholesterol diet.

FICTION.  It might seem like common sense to stop eating foods that have cholesterol in them when your blood cholesterol is high. But it’s really more about the type of fat that you eat that affects your cholesterol levels. Both saturated and trans fats can cause your cholesterol levels to be high. Saturated fat is found in red meat, poultry skin, butter, cheese, whole and 2% milk and regular ice cream. Trans fat is found in shortening, some margarines, some fast foods and many store-bought cookies and crackers. Use healthier fats instead, such as olive oil, canola oil and peanut oil, as well as tub margarines that are “trans fat-free.” While it’s still a good idea to eat fewer high cholesterol foods, such as eggs and other animal foods, it’s more important to choose the right kind of fat for eating and cooking.


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